15143 (SFD)P.O. BOX 1504
Building LA pUINTA, CALIFORNIA92253
Address 47--8i� gia �ireaaz.e -
Owner
rcentury Roues Cor=ltitips
No. 15143
Mailing BUILDING: TYPE CONST.' N OCC: GRP. R3
Address 1.535 South U Street
A.P. Number 017-796-015
City Zip Tel. y,
Sap. .$ernadl 92408 1909-381-6007 Legal Description Lot 15:' Tract - 26152 Phase
Contractor- Project Description S `� ' Tan • GL
same as dbov4e
Address. ; innaker C®Ve••at Lake Laa Quinta
•.. ,
State Lic. City
& Classif. B31447.3 Lic. # 2i2o
`Arch., Engr.;
Designer 1?raIik ,Gonzales & Associates
Address'- Tel.
13366._ �sast .Chapman. Ave. 714,--532-6878
City _ Zip State
ora;ige,.- '� 92666 Lic. #
�! yLICENSED CONTRACTOR'S DECLARATION.
I hereby affirm that'I'am licensed under provisions of Chapter) (commencing with Sectia
7000);of Division`3 of the Bu$iness and'Prrofessions.Gode,�and my license is ir, ( f rceran
eHorf d' _..stir' �'Y _ 1� ....+' .- i.n
OWNEWIith—LDER DECLARATION
I hereby affirm, that I am�exemptfrom the Contractor's License Law for.the following
reason: (Sec. 7031.5,Busmess`and Professions Code: Any city or county which, requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for,such permit to rile a signed statement that he is licensed pursuait to
the provisions; of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he.is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ I, as owner of the property,.or my employees with wages as .their. sole, compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves .thereon and who does such work -himself or through his own employees,
provided that such Improvements are not intended or offered for sale. If, however, the butlding
or improvement is sold within one year of completion,the owner -builder will have the burden
of proving that he did not build or bnprove for the purpose of sale.)
❑ I, ae owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and •Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. .- B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm. that I have a certificate of.consent to self -insure, or a certificate, of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city, O Certified copy is hereby furnished. 1
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
` or less.)
I certify that in the performance of the work for which this permitis'issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date• owner'
NOTICE TO APPLICANT:—H, after, making this Certificate of Exemption you should become
subject to the Workers' -Compensation provisions of the, Labor Code, you must forthwith.
comply with such provisions or this permit shall be deemed revoked. '
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,AND -
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND—CIVIL—FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO.THE COST OF COMPENSATION, .
DAMAGES AS.PROVIDED FOR IN SECTION:3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.'•
This is a building permit when properly filled out,°signed and validated, and is subject to
expiration if work thereunder. is suspended for 180 -days.
I certify that I have read thisappllcation,ar4 state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to•buifding
construction, and herebyjauthorize-'representatives of this ity to enter the *above-.
mentioned property for inspection purposes.
Signature of applicant. �✓ 1✓'' Date r
Mailing.Address�
City, State, Zip _-
Sq. Ft.ii36 _No. '
Size Stories
New Iii Add ❑ : ,, • Alter ❑
No. Dw.
Units
Repair ❑ Demolitior'.O
Estimated Valuation
-I'l.72,969.00
PERMIT
AMOUNT
Plan Chk. Dep. -
Plan Chk. Bal.
•
Const.
W
Mech.
Electrical
19,
Plumbing
IWO • (
S.M.I.
$)
Grading
L . °' tp
Driveway Enc.
Infrastructure
_
esti n 1 11AZ l' 2 a r5
rs... .c
TOTAL
.HF -MARKS
ZONE: BY'
-Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property. Line
FINAL DATE INSPECTOR ~
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINii �•,
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (ROUGH)
METER LOOP
WALL SQ. FT.
HEATING (FINAL)
DRINKING FOUNTAIN
SO. FT. ®
AS (FINAL) e45
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
CU. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SQ.FT.GAR ® 3/.c
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACKGROUND
PLUMBII
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWE FVSfi
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL J
AS (FINAL) e45
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING /'
`��/ /J�
�fl//J
`�'v 71169 `
j
/ J
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION ,
w
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL